1215 NE 97 St•
' SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building
I other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores
Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regula-
ns of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans
d specifications must be kept at building during progress of the work.
'/ -
Owner's Name and Address .;, 11 ) /)
' Registered Architect and /or Engine
Name and address of licensed contractor
Location and legal description of lot to be built on:
Block_ Subdivision
Street and Number where work is to be done_____________________
State work to be done and purpose of building (by floors)
Disapproved _______________ Date
(Signed)
___________,__ _and for no other purpose.
New Building__ __ Remodeling Addition _ Repairs No. of
/�
To be constructed of �+ � � ~___ Kind of fo,. ndatioaO_ei �: �! Roof Covering 2:e.2
Estimated Total cost of improvements $___ Ji }' v Amount of P $
Zone cubage required__ r" )' `it`) _Plan Cubage__
Distance to next nearest building________ _— _ _Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for saiS building. All notices with reference to the building and its construction may
be sent to
Building Inspector My Commission Expires
The undersigned applicant for this building permit does herebltiriertify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensate ti Act being' Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, an . will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; nd will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The uncle 'fined agrees to employ only such subcpntractors, on wor to)e performed under this
permit, as are licensed by Miami Shores Village: A
Remarks (Signed) cr
STATE OF FLORIDA,
COUNTY 'OF DADE.
Notary Public, State of Florida
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared -
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No 006 �j n l� Date Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved____ Date Disapproved ____Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.